08. Costing Essential Services Package An Issue Paper

Costing Essential Services Package: An Issue Paper 14
6. Policy, Regulation, NGO, Private Sector (PRNP)
7. Other Public Health Services (OPHS)
8. Other Health and Nutrition Services (OHNS).
In costing total expenditure for ESP (TEESP) it has been assumed that the first component i.e.;
ESP is totally (fully) included in the TEESP, and in each non-ESP (7 components) component,
there is ESP in varied degree which is included in TEESP. Thus, methodologically, PPC has
divided the expenditure of HPSP into two broad categories (Figures 9 and 10):
� expenditures for ESP delivery; and
� expenditures for other HPSP activities (denoted as non-ESP) including those which are
directly or indirectly related to ESP delivery and hospital services.
As part of the PPC’s ESP costing exercise, several Task Forces (TF) were constituted by the
MOHFW to deal with the issue in line with the HPSP components. The TFs categorised the
activities among seven components considering mainly the ease and convenience of
management, i.e., considering which line manager will better administer which component of
HPSP. As a result of such consideration, it is not possible to separate out all the activities
directly related to ESP in one component (ESP delivery) from the components, which are also
related to ESP delivery. Hence, some of the HPSP components other than ESP delivery also
include some activities that are directly related to ESP delivery. For example, training of the
grass-root levels staff and officials (at thana level or below) for ESP is an activity under the HRD
component. But this is definitely an ESP activity, not included in the component 1 i.e., ESP
delivery (GoB 1998a: 71).
Before the pre-appraisal mission, following a top-down procedure, a notional estimate of costs
of ESP delivery activities was obtained. This estimate was included in the original PIP for preappraisal.
The procedural steps adopted in this top-down exercise were as follows:
(a) notional determination of amount of expenditure for each component,
(b) allocation of amounts by activities and sub-activities.
A Working Group, formed during the pre-appraisal, revisited and further refined the estimate.
After the mission, the estimate was placed at a workshop with technical group for finalization.
The workshop participants pointed out several changes required in the estimate, and constituted
two Review Groups for reviewing the estimate. The two Review Groups consulted a large
number of concerned persons and finally obtained an estimate for each intervention by level of
care (GoB 1998a : 72).
After pre-appraisal, the estimation procedure incorporated the bottom-up approach. According
to this procedure, the personnel of the relevant departments first identified the activities and
sub-activities to be conducted in the first year of HPSP to produce each ESP outcome over the
targeted coverage. Thereafter they assessed the type of inputs/line items of costs and the
amount of costs for each type of inputs to be used to produce each unit of outcome. Then the
total costs for each outcome was estimated at the current market price, and finally the grand
total of ESP delivery expenditures was obtained for the first year – 1998-99. The costs have
been shown in three broad groups – manpower, commodities and contingency. In calculating
the cost of manpower, the impact of the new pay scale has been considered. In calculating the
cost of manpower to be engaged in ESP delivery activities in year-1, the salaries and
allowances as in the earlier scale have been increased by 40 percent. The cost of commodities
and contingency items has been calculated at the existing market prices. The costs for